About 3% of all people with diabetes develop foot ulcers. This is a late complication of this metabolic disease and often ends in amputation. Innovative, interdisciplinary wound management can help improve outcomes considerably – this was the consensus of the experts who attended the specialist workshop Innovative Wound Management – The Challenge of Diabetic Foot Syndrome, organized for the press by Lohmann & Rauscher (L&R) in Vienna on 27 January, 2016. The workshop addressed the question of how to meet the challenge of diabetic foot syndrome (DFS). It demonstrated that local wound therapy and an interdisciplinary approach is the key to successful management: I.e. effective and low-pain debridement (e.g. with Debrisoft) combined with phase-oriented wound management using modern dressings (Suprasorb) as well as the negative pressure therapy system Suprasorb CNP (Controlled Negative Pressure). According to one of the experts, the system’s therapy units and components, such as the negative pressure dressing for extremities, Suprasorb CNP EasyDress, make it much easier for doctors and nursing staff to apply negative pressure therapy, e.g. on the lower leg, and also markedly improve conditions for wound healing.
There are currently about eight million people with diabetes in Germany – and the number is growing. As Dr Claudia Ellert, senior physician in vascular surgery, Lahn-Dill-Kliniken, Wetzlar, explained, among the challenges of this metabolic disease are late complications such as diabetic foot, which affects approximately one in four people with diabetes in their lifetime. She added, “Diabetic foot is the most common cause of amputation in Germany. In many cases, amputation could have been avoided with a multidisciplinary treatment approach.”
Anita Mysor, wound manager, Krefeld/Berlin, further explained, “The long-term goal is to prevent the development of foot ulcers as much as possible. Effective wound management primarily addresses the question as to why a wound develops.” Both pressure protection and patient counselling and training are important factors here. “If ulceration has occurred, treatment primarily involves controlling infection, healing the ulcers, alleviating pain and applying modern wound therapy,” she continued.
Phase-oriented moist wound management
Lower leg ulcers covering a large surface area in particular tend to have a protracted course in inpatient and outpatient settings. The first step is generally surgical debridement. In the case of less extensive and superficial wounds, the innovative monofilament fibre pad from L&R (Debrisoft) can also be used for fast, efficient and low-pain mechanical debridement.1
“The clean wound is then further treated with the appropriate wound dressings, depending on the wound healing phase. The aim is to promote granulation and epithelization of the wound,” explained Anita Mysor. L&R offers products that specifically cater for every wound healing phase, such as the hydroactive dressing Suprasorb Liquacel, the particularly skin-friendly silicone foam dressing Suprasorb P silicone, the collagen wound dressing Suprasorb C and the antimicrobial HydroBalance dressing Suprasorb X + PHMB.
The HydroBalance system in Suprasorb X + PHMB reduces pain and promotes wound healing. In clinical practice recommendations, Suprasorb X + PHMB is recommended for the treatment of critically colonized and locally infected wounds.2
Negative pressure therapy in the treatment of complex wounds
As Dr Claudia Ellert pointed out, negative pressure therapy is considered the gold standard in the treatment of complex wounds following debridement, adding: “The even distribution of pressure over the entire wound surface improves local blood circulation, reduces oedema, growth inhibitors and microbial load, stimulates cell proliferation and formation of granulation tissue and helps approximate the wound edges.” Data from Armstrong et al.3 also confirm the benefits of negative pressure therapy: In 162 patients who underwent minor amputation due to diabetic foot, the healing rate after 112 days with negative pressure therapy was 56% compared to 39% with conventional moist wound management. The time to wound healing was 56 and 77 days, respectively. Dr Claudia Ellert summarized the findings as follows: “These results show that negative pressure therapy leads to more effective wound healing and wound closure, provides a better quality of life for the patient and results in shorter hospital stays and thus lower treatment costs.”
Suprasorb CNP EasyDress: easy, fast and gentle on the skin
Whereas the application of negative pressure dressings often used to be difficult and very time-consuming, it is now easy, fast and gentle on the skin with the innovative Suprasorb CNP EasyDress. “With Suprasorb CNP EasyDress combined with, for example, antimicrobial gauze as wound filler, L&R has now developed a system that makes the use of negative pressure therapy on the extremities both even more convenient for the user and significantly promotes/simplifies the conditions for wound healing,” commented Dr Claudia Ellert. The negative pressure dressing is applied considerably more quickly than is the case with conventional dressing methods. This translates to time savings of up to 90%.4 Dr Claudia Ellert: “Using antimicrobial gauze on the wound as the contact layer also makes it possible to use this dressing to cover large wound surfaces. The film tube is then simply pulled over the extremity as a secondary dressing and fastened with narrow retention strips on intact skin far from the wound. This protects the sensitive area surrounding the wound. The high water vapour permeability of the special film in EasyDress also improves moisture management beneath the dressing.”
Optimal solutions for all challenges in wound management
“L&R collaborates closely with users in in- and outpatient care facilities and takes into account user and patient needs in the needs-analysis phase, as well as during the product development and application phases,” commented Dr Christian Rohrer, Head of Research and Development at L&R, describing the work of the R&D Department. “To ensure the success of our innovations, we have institutionalized the process of innovation management, and we seek out technologies and ideas, evaluate them and implement them in close, confidential collaboration with users and patients.”
“The aim of L&R in wound management is to meet the needs of doctors, nursing staff and wound experts with optimal care solutions for every type of wound in every wound healing phase,” explained Wolfgang Süßle, L&R’s CEO. “This means that our mission goes way beyond just providing optimal product solutions. To adequately address the problems, we must also provide services, concepts and guidance that go beyond the product itself and support patient care by means of practice-oriented, scientifically sound guidelines and recommendations.”
Sources:
(1) Bahr, S., Mustafi, N., Hättig, P. et al. Clinical efficacy of a new monofilament fibre-containing wound debridement product. Journal of Wound Care (2011) 20(5): 242 – 248.
(2) Dissemond J, Gerber V, Kramer A, Riepe G, Strohal R, Vasel-Biergans A, Eberlein T: Praxisorientierte Expertenempfehlung zur Behandlung kritisch kolonisierter und lokal infizierter Wunden mit Polihexanid, Wundmanagement (2009) 3(2): 62-68 und Zeitschrift für Wundbehandlung (2009) 14(1): 20-26
(3) Armstrong et al. Negative Pressure Wound Therapy After Partial Diabetic Foot Amputation Negative. Lancet, 2005
(4) Duft M, Ostapowicz D, de Lange S, Griesshammer K, Abel M: Audit on the usability, user and patient satisfaction of tubular bandage. Multi-center international post-marketing study under real conditions, 2015
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